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Health Exchange and Essential Health Benefits

Through Connect for Health Colorado, individuals and employers can buy health insurance as a part of a larger purchasing pool.  Employers with 50 employees or fewer are eligible to purchase coverage (states may decide to allow larger employers to access exchanges from 2017 onward).  

Individuals with incomes between 100 percent and 400 percent ($11,770 – $47,080) of the Federal Poverty Level (FPL) are eligible to purchase federally subsidized coverage. Income ranges for larger households can be found here.

Under PPACA, all health plans must cover ten essential health benefits. Click here for a full description of these benefits. By purchasing coverage through a health insurance exchange, individuals and employers may be eligible for certain tax credits or subsidies.

According to the Kaiser Family Foundation, there are generally four types of ‘metal’ coverage available through the Marketplace, plus ‘catastrophic’ plans.

  • Catastrophic: The health plan pays less than 60% of the total average cost of care on average, with consumers paying the balance. These plans are only available to people who are under 30 years old at the beginning of the plan year, or those who have a hardship or affordability exemption.
  • Bronze: The health plan pays 60% on average. Consumer pays about 40%.
  • Silver: The health plan pays 70% on average. Consumer pays about 30%. Consumers eligible for cost-sharing reductions can only receive them by enrolling in a silver plan.
  • Gold: The health plan pays 80% on average. Consumer pays about 20%.
  • Platinum: The health plan pays 90% on average. Consumer pays about 10%.

Click here for a state-by-state breakdown of coverage and more information on the plans listed above.